A view of excellence for the future of medical mycology in Clinical Microbiology and Infection
Authors: Thomas J. Walsh, Ana Alastruey-Izquierdo
Journal: Clinical Microbiology and Infection (2023)

Isaac Newton in 1665 wrote, “If I have seen further [than others], it is by standing on the shoulders of giants” [[1]Newton I. Letter from sir isaac Newton to Robert Hooke. Historical Society of Pennsylvania, 1675https://discover.hsp.org/Record/dc-9792/Description#tabnavDate accessed: July 11, 2023Google Scholar]. The editorial board of Clinical Microbiology and Infection (CMI) has greatly benefited from Emmanuel Roilides, a giant in the field of medical mycology, whose expertise, as editor in medical mycology, brought high-quality manuscripts to publication over 16 years of distinguished service to the journal. As we take helm of medical mycology in CMI, we stand on these shoulders and look to the future to bring the best translational and clinical research in medical mycology to the readership of CMI. Through publication of original studies, reviews and commentaries in infectious diseases and clinical microbiology, CMI aims to provide accurate, timely, and instructive reports with special attention to methodology and clear presentation of results. Building upon CMI's 2022 impact factor of 14.2 and a CiteScore of 21.5, we shall aim to recruit, receive, review, and publish quality research that will have enduring impact on the field of medical mycology, clinical microbiology, and infectious diseases. We shall also encourage submission of timely systematic review papers on topics of mycological importance that will support the educational mission of the journal. As the mission of the European Society of Clinical Microbiology and Infectious Diseases is “to improve the diagnosis, treatment and prevention of infection-related diseases,” we will encourage submission of leading-edge papers that fulfil these important objectives in the various disciplines of medical mycology. These include but are not limited to epidemiology, diagnostic methods, clinical management, guidelines, antifungal drug resistance, immunogenetics, host defences, pharmacology, and new therapeutics. In today's landscape, the realm of medical mycology stands poised for accelerated research advancement. A significant catalyst has emerged in the form of the recently unveiled fungal priority pathogen list by the WHO, spotlighting 19 fungal pathogens [[2]World Health Organization WHO fungal priority pathogens list to guide research, development and public health action. World Health Organization, Geneva2022Google Scholar]. These infections, long consigned to the shadows of awareness and research funding, present difficult challenges for seasoned clinicians. Within the pages of this pivotal document, several important gaps have been detected: from the true burden of disease to diagnostic methodologies, from essential antifungal treatments to comprehensive surveillance and proactive public health interventions. CMI embraces its role in advancing this important discourse. We stand committed to fulfil the gaps detected within this compendium, earnestly striving to foster publications in these areas. CMI has a strong tradition of publishing epidemiological studies in medical mycology [3Jeong W. Keighley C. Wolfe R. Lee W.L. Slavin M.A. Kong D.C.M. et al.The epidemiology and clinical manifestations of mucormycosis: a systematic review and meta-analysis of case reports.Clin Microbiol Infect. 2019; 25: 26-34https://doi.org/10.1016/j.cmi.2018.07.011Abstract Full Text Full Text PDF PubMed Scopus (460) Google Scholar, 4Petrikkos G. Skiada A. Drogari-Apiranthitou M. Epidemiology of mucormycosis in Europe.Clin Microbiol Infect. 2014; 20: 67-73https://doi.org/10.1111/1469-0691.12563Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar, 5Gamaletsou M.N. Walsh T.J. Zaoutis T. Pagoni M. Kotsopoulou M. Voulgarelis M. et al.A prospective, cohort, multicentre study of candidaemia in hospitalized adult patients with haematological malignancies.Clin Microbiol Infect. 2014; 20 (O50–7)https://doi.org/10.1111/1469-0691.12312Abstract Full Text Full Text PDF Scopus (80) Google Scholar, 6Kariyawasam R.M. Dingle T.C. Kula B.E. Vandermeer B. Sligl W.I. Schwartz I.S. Defining COVID-19-associated pulmonary aspergillosis: systematic review and meta-analysis.Clin Microbiol Infect. 2022; 28: 920-927https://doi.org/10.1016/j.cmi.2022.01.027Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar]. Understanding the burden of fungal disease and recognition of emerging pathogens is essential to enhancing clinical awareness and establishing public policy for research priorities. Reports from consortia of countries describing prospective global trends of fungal diseases provide important sentinels for development of emerging threats to our patients. Such trends are often linked to emergence of resistance fungal pathogens, such as that observed in voriconazole-resistant Aspergillus fumigatus [[7]Lestrade P.P.A. Meis J.F. Melchers W.J.G. Verweij P.E. Triazole resistance in Aspergillus fumigatus: recent insights and challenges for patient management.Clin Microbiol Infect. 2019; 25: 799-806https://doi.org/10.1016/j.cmi.2018.11.027Abstract Full Text Full Text PDF PubMed Scopus (108) Google Scholar], as well as fluconazole and multidrug-resistant Candida auris [[8]Pristov K.E. Ghannoum M.A. Resistance of Candida to azoles and echinocandins worldwide.Clin Microbiol Infect. 2019; 25: 792-798https://doi.org/10.1016/j.cmi.2019.03.028Abstract Full Text Full Text PDF PubMed Scopus (295) Google Scholar]. Emerging patterns of fluconazole-resistance in Candida albicans and Candida parapsilosis pose further global public health threat, especially in developing nations. Outbreaks of invasive fungal diseases, such as that reported with Exserohilum meningitis and the ongoing investigation of Fusarium meningitis, exemplify the public health threats, which CMI would consider a priority. CMI has a distinguished record of publishing clinical diagnostic mycological studies and reviews [9Senécal J. Smyth E. Del Corpo O. Hsu J.M. Amar-Zifkin A. Bergeron A. et al.Non-invasive diagnosis of Pneumocystis jirovecii pneumonia: a systematic review and meta-analysis.Clin Microbiol Infect. 2022; 2: 23-30https://doi.org/10.1016/j.cmi.2021.08.017Abstract Full Text Full Text PDF Scopus (12) Google Scholar, 10Dornbusch H.J. Groll A. Walsh T.J. Diagnosis of invasive fungal infections in immunocompromised children.Clin Microbiol Infect. 2010; 16: 1328-1334https://doi.org/10.1111/j.1469-0691.2010.03336.xAbstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar, 11Prattes J. Wauters J. Giacobbe D.R. Salmanton-García J. Maertens J. Bourgeois M. et al.Risk factors and outcome of pulmonary aspergillosis in critically ill coronavirus disease 2019 patients-a multinational observational study by the European Confederation of Medical Mycology.Clin Microbiol Infect. 2022; 28: 580-587https://doi.org/10.1016/j.cmi.2021.08.014Abstract Full Text Full Text PDF PubMed Scopus (104) Google Scholar, 12Ullmann A.J. Aguado J.M. Arikan-Akdagli S. 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Rapid and sensitive diagnosis of fungal keratitis with direct PCR without template DNA extraction.Clin Microbiol Infect. 2014; 20: O776-O782https://doi.org/10.1111/1469-0691.12571Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar, 19Orasch C. Marchetti O. Garbino J. Schrenzel J. Zimmerli S. Mühlethaler K. et al.Candida species distribution and antifungal susceptibility testing according to European Committee on Antimicrobial Susceptibility Testing and new vs. old Clinical and Laboratory Standards Institute clinical breakpoints: a 6-year prospective candidaemia survey from the fungal infection network of Switzerland.Clin Microbiol Infect. 2014; 20: 698-705https://doi.org/10.1111/1469-0691.12440Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar, 20Arendrup M.C. Update on antifungal resistance in Aspergillus and Candida.Clin Microbiol Infect. 2014; 20: 42-48https://doi.org/10.1111/1469-0691.12513Abstract Full Text Full Text PDF PubMed Scopus (163) Google Scholar, 21Lass-Flörl C. Susceptibility testing in Aspergillus species complex.Clin Microbiol Infect. 2014; 20: 49-53https://doi.org/10.1111/1469-0691.12514Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar]. New molecular platforms, in the form of advance nucleic acid amplification systems [[18]Zhao G. Zhai H. Yuan Q. Sun S. Liu T. Xie L. Rapid and sensitive diagnosis of fungal keratitis with direct PCR without template DNA extraction.Clin Microbiol Infect. 2014; 20: O776-O782https://doi.org/10.1111/1469-0691.12571Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar,[22]Imbert S. Gauthier L. Joly I. Brossas J.Y. Uzunov M. Touafek F. et al.Aspergillus PCR in serum for the diagnosis, follow-up and prognosis of invasive aspergillosis in neutropenic and nonneutropenic patients.Clin Microbiol Infect. 2016; 22 (e1–8): 562https://doi.org/10.1016/j.cmi.2016.01.027Abstract Full Text Full Text PDF Scopus (53) Google Scholar], nuclear magnetic resonance systems, proteomic platforms, including matrix assisted laser desorption time of flight (MALDI-TOF) spectroscopy, diagnostic metagenomics, and artificial intelligence/machine learning will likely accelerate laboratory detection and afford earlier targeted antifungal therapy. Innovative immunologic assays for antigen detection, including lateral flow through devices, will pave the way for point of care assessment and early treatment [[14]Lass-Flörl C. Samardzic E. Knoll M. Serology anno 2021-fungal infections: from invasive to chronic.Clin Microbiol Infect. 2021; 27: 1230-1241https://doi.org/10.1016/j.cmi.2021.02.005Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar]. CMI supports publications of reports on the risk factors for invasive fungal diseases [[11]Prattes J. Wauters J. Giacobbe D.R. Salmanton-García J. Maertens J. Bourgeois M. et al.Risk factors and outcome of pulmonary aspergillosis in critically ill coronavirus disease 2019 patients-a multinational observational study by the European Confederation of Medical Mycology.Clin Microbiol Infect. 2022; 28: 580-587https://doi.org/10.1016/j.cmi.2021.08.014Abstract Full Text Full Text PDF PubMed Scopus (104) Google Scholar]. We are interested in the emerging challenges to innate host response to invasive fungal pathogens, including viruses such as COVID-19, influenza, and cytomegalovirus, the expanding use of immune checkpoint inhibitors, and anti-cytokine antibodies. We also need to understand the role of immunogenetic risk factors for the development of invasive fungal diseases. Polymorphisms in genes encoding STAT1, CARD-9, MyD88, pattern recognition receptors such as Toll-like receptors and C-type lectin receptors, and other proteins of the innate and adaptive host defence systems against invasive fungal diseases merit further investigation. Further studies of primary immune deficiencies and their relation to development of invasive fungal diseases further strengthen our understanding of the immunogenetic basis of human mycoses [[23]Moratti M. Conti F. Giannella M. Ferrari S. Borghesi A. How to: diagnose inborn errors of intrinsic and innate immunity to viral, bacterial, mycobacterial, and fungal infections.Clin Microbiol Infect. 2022; 28: 1441-1448https://doi.org/10.1016/j.cmi.2022.07.021Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar]. CMI is an important forum for publication of international guidelines in diagnosis and treatment of invasive fungal diseases [[24]Warris A. Lehrnbecher T. Roilides E. Castagnola E. Brüggemann R.J.M. Groll A.H. ESCMID-ECMM guideline: diagnosis and management of invasive aspergillosis in neonates and children.Clin Microbiol Infect. 2019; 25: 1096-1113https://doi.org/10.1016/j.cmi.2019.05.019Abstract Full Text Full Text PDF PubMed Scopus (101) Google Scholar,[25]Tortorano A.M. Richardson M. Roilides E. van Diepeningen A. Caira M. Munoz P. et al.ESCMID and ECMM joint guidelines on diagnosis and management of hyalohyphomycosis: Fusarium spp., Scedosporium spp. and others.Clin Microbiol Infect. 2014; 20: 27-46Abstract Full Text Full Text PDF PubMed Scopus (350) Google Scholar]. We encourage the submission of phase 2 and phase 3 randomized clinical trials, reviews, and commentaries on the efficacy, pharmacokinetics, pharmacogenetics, safety, and tolerability of new antifungal agents or licensed antifungal agents used in novel strategies [26Kyvernitakis A. Torres H.A. Jiang Y. Chamilos G. Lewis R.E. Kontoyiannis D.P. Initial use of combination treatment does not impact survival of 106 patients with haematologic malignancies and mucormycosis: a propensity score analysis.Clin Microbiol Infect. 2016; 22 (e1–811.e8): 811https://doi.org/10.1016/j.cmi.2016.03.029Abstract Full Text Full Text PDF PubMed Scopus (103) Google Scholar, 27Sehgal I.S. Dhooria S. Choudhary H. Aggarwal A.N. Garg M. Chakrabarti A. et al.Monitoring treatment response in chronic pulmonary aspergillosis: role of clinical, spirometric and immunological markers.Clin Microbiol Infect. 2019; 25 (e1–1157.e7): 1157https://doi.org/10.1016/j.cmi.2019.01.007Abstract Full Text Full Text PDF Scopus (23) Google Scholar, 28Koehler P. Bassetti M. Kochanek M. Shimabukuro-Vornhagen A. Cornely O.A. Intensive care management of influenza-associated pulmonary aspergillosis.Clin Microbiol Infect. 2019; 25: 1501-1509https://doi.org/10.1016/j.cmi.2019.04.031Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar, 29Lestrade P.P.A. Meis J.F. Melchers W.J.G. Verweij P.E. Triazole resistance in Aspergillus fumigatus: recent insights and challenges for patient management.Clin Microbiol Infect. 2019; 25: 799-806https://doi.org/10.1016/j.cmi.2018.11.027Abstract Full Text Full Text PDF PubMed Scopus (106) Google Scholar]. For treatment of deeply invasive fungal diseases, there is currently a greatly needed pipeline of investigational antifungal agents, including but not limited to ibrexafungerp, olorofim, fosmanogepix, oteseconazole, opelconazole, ATI-2307, GR2397, MAT2203, cochleate formulations of amphotericin B, and structurally modified molecules of amphotericin B, for which we welcome studies of preclinical efficacy, early clinical treatment, and comparative efficacy. CMI is also dedicated to reporting advances in therapeutic immunomodulation of invasive fungal diseases [30Cifaldi C. Ursu G.M. D'Alba I. Paccoud O. Danion F. Lanternier F. et al.Main human inborn errors of immunity leading to fungal infections.Clin Microbiol Infect. 2022; 28: 1435-1440https://doi.org/10.1016/j.cmi.2022.06.031Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar, 31Carvalho A. Cunha C. Bistoni F. Romani L. 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Augmentation of innate and adaptive host defences is yet another strategy that may improve therapeutic outcomes in invasive fungal diseases. Emerging immunological strategies, such as use of recombinant sargramostim augments innate host response to invasive fungal diseases. Preclinical data supporting blockade of PD-1/PD-L1 demonstrating efficacy against murine models of pulmonary aspergillosis and mucormycosis are also encouraging developments. Preclinical studies and human trials of vaccines, such as those being developed for candidiasis, cryptococcosis, histoplasmosis, blastomycosis, and other important fungal diseases, are also welcome advances. In summary, the field of medical mycology is achieving major advances across multiple disciplines, including epidemiology, laboratory detection systems, antifungal resistance, immunogenetics, host defences, pharmacology, and new therapeutics. In supporting the mission of CMI, we therefore enthusiastically welcome important advances in our dynamic field for consideration of publication in CMI. Astellas; F2G; Gilead; Lediant; Merck; Omeros; Scynexis; Shionogi; T2 Biosystems; Abbott Laboratories; Karyopharm; Partner Therapeutics?Astellas; F2G; Gilead; Lediant; Merck; Omeros; Scynexis; Shionogi; T2 Biosystems; Abbott Laboratories; Laboratories; Karyopharm; and Partner Therapeutics. T.J.W has received grants for experimental and clinical antimicrobial pharmacology, therapeutics, and diagnostics to his institutions from Astellas, F2G, Gilead, Lediant, Merck, Omeros, Scynexis, Shionogi, T2 Biosystems; and served as consultant to Abbott Laboratories, Astellas, F2G, Gilead, Karyopharm, Lediant, Omeros, Partner Therapeutics, Scynexis, Shionogi, Statera, and T2 Biosystems. He also serves on the Scientific Steering Committee and as a Senior Advisor for the Mycoses Study Group-Education and Research Consortium (MSG-ERC), as well as Senior Advisor to the Medical Mycological Society of the Americas, the Henry Schueler Foundation Scholar in Mucormycosis of the Henry Schueler Foundation, Investigator of Emerging Infectious Diseases of the Save Our Sick Kids Foundation, Vice-Chair of the Fungal Nomenclature Working Group of the International Society for Human and Animal Mycology, and Founding Director of the Centre for Innovative Therapeutics and Diagnostics (citdx.org). A.A.I. serves as Chair of the Fungal Infection Study Group (EFISG) for European Society of Clinical Microbiology and Infectious Diseases and as Chair of the Technical Expert group for the development of the Fungal Priority Pathogen List by the WHO. Editorial note: not peer-reviewed. T.J.W. was supported for this work by the Henry Schueler Foundation as the Henry Schueler Foundation Scholar in Mucormycosis.